Harmonising clinical trials within the Gynecologic Cancer InterGroup: consensus and unmet needs from the Fifth Ovarian Cancer Consensus Conference

The Gynecologic Cancer InterGroup (GCIG) Fifth Ovarian Cancer Consensus Conference (OCCC) was held in Tokyo, Japan from 7 to 9 November 2015. It provided international consensus on 15 important questions in 4 topic areas, which were generated in accordance with the mission statement to establish 'International Consensus for Designing Better Clinical Trials'. The methodology for obtaining consensus was previously established and followed during the Fifth OCCC. All 29 clinical trial groups of GCIG participated in program development and deliberations. Draft consensus statements were discussed in topic groups as well as in a plenary forum. The final statements were then presented to all 29 member groups for voting and documentation of the level of consensus. Full consensus was obtained for 11 of the 15 statements with 28/29 groups agreeing to 3 statements, and 27/29 groups agreeing to 1 statement. The high acceptance rate of the statements among trial groups reflects the fact that we share common questions, and recognise important unmet needs that will guide future research in ovarian cancer.

Dimensionality Driven Enhancement of Ferromagnetic Superconductivity in URhGe

In most unconventional superconductors, like the high-T_{c} cuprates, iron pnictides, or heavy-fermion systems, superconductivity emerges in the proximity of an electronic instability. Identifying unambiguously the pairing mechanism remains nevertheless an enormous challenge. Among these systems, the orthorhombic uranium ferromagnetic superconductors have a unique position, notably because magnetic fields couple directly to ferromagnetic order, leading to the fascinating discovery of the reemergence of superconductivity in URhGe at a high field. Here we show that uniaxial stress is a remarkable tool allowing the fine-tuning of the pairing strength. With a relatively small stress, the superconducting phase diagram is spectacularly modified, with a merging of the low- and high-field superconducting states and a significant enhancement of the superconductivity. The superconducting critical temperature increases both at zero field and under a field, reaching 1 K, more than twice higher than at ambient pressure. This enhancement of superconductivity is shown to be directly related to a change of the magnetic dimensionality detected from an increase of the transverse magnetic susceptibility: In addition to the Ising-type longitudinal ferromagnetic fluctuations, transverse magnetic fluctuations also play an important role in the superconducting pairing.

Mid-trimester residual cervical length and the risk of preterm birth in pregnancies after abdominal radical trachelectomy: a retrospective analysis

OBJECTIVE

To investigate the association between mid-trimester residual cervical length (CL) and the risk of preterm birth in pregnancies after abdominal radical trachelectomy (RT).

DESIGN

Retrospective cohort study.

SETTING

University hospital.

POPULATION

A total of 33 deliveries after 22 weeks' gestation in 30 women who underwent abdominal RT including prophylactic cervical cerclage and perinatal care between January 2002 and May 2016.

METHODS

The association between mid-trimester residual CL (the distance between the cerclage and the external cervical os) and gestational age at delivery was investigated. Receiver-operating characteristics (ROC) curve analysis was performed to estimate the optimal cut-off values of the mid-trimester residual CL for the prediction of preterm birth.

MAIN OUTCOME MEASURES

Preterm birth before 34 weeks' gestation.

RESULTS

Mid-trimester residual CL showed a significant correlation with gestational age at delivery (r = 0.36, P < 0.05). There was a significant difference in residual CL between women who did and those who did not give birth before 34 weeks (P < 0.05). Mid-trimester residual CL < 13 mm was a good predictor of birth before 34 weeks, with a sensitivity of 67%, specificity of 75%, positive predictive value of 55% and negative predictive value of 86% (area under ROC curve, 0.75).

CONCLUSIONS

Mid-trimester residual CL is significantly correlated with gestational age at delivery. Residual CL assessment could be used to reassure physicians and women that there is only a small chance of preterm birth in pregnancies after abdominal RT.

TWEETABLE ABSTRACT

Mid-trimester residual cervical length is a good predictor of preterm birth after radical trachelectomy.

Fifth Ovarian Cancer Consensus Conference of the Gynecologic Cancer InterGroup: recurrent disease

This manuscript reports the consensus statements regarding recurrent ovarian cancer (ROC), reached at the fifth Ovarian Cancer Consensus Conference (OCCC), which was held in Tokyo, Japan, in November 2015. Three important questions were identified: (i) What are the subgroups for clinical trials in ROC? The historical definition of using platinum-free interval (PFI) to categorise patients as having platinum-sensitive/resistant disease was replaced by therapy-free interval (TFI). TFI can be broken down into TFIp (PFI), TFInp (non-PFI) and TFIb (biological agent-free interval). Additional criteria to consider include histology, BRCA mutation status, number/type of previous therapies, outcome of prior surgery and patient reported symptoms. (ii) What are the control arms for clinical trials in ROC? When platinum is considered the best option, the control arm should be a platinum-based therapy with or without an anti-angiogenic agent or a poly (ADP-ribose) polymerase (PARP) inhibitor. If platinum is not considered the best option, the control arm could include a non-platinum drug, either as single agent or in combination. (iii) What are the endpoints for clinical trials in ROC? Overall survival (OS) is the preferred endpoint for patient cohorts with an expected median OS < or = 12 months. Progression-free survival (PFS) is an alternative, and it is the preferred endpoint when the expected median OS is > 12 months. However, PFS alone should not be the only endpoint and must be supported by additional endpoints including pre-defined patient reported outcomes (PROs), time to second subsequent therapy (TSST), or time until definitive deterioration of quality of life (TUDD).

Field-induced magnetic instability within a superconducting condensate

The application of magnetic fields, chemical substitution, or hydrostatic pressure to strongly correlated electron materials can stabilize electronic phases with different organizational principles. We present evidence for a field-induced quantum phase transition, in superconducting Nd_0.05Ce_0.95CoIn₅, that separates two antiferromagnetic phases with identical magnetic symmetry. At zero field, we find a spin-density wave that is suppressed at the critical field μ₀H* = 8 T. For H > H*, a spin-density phase emerges and shares many properties with the Q phase in CeCoIn₅. These results suggest that the magnetic instability is not magnetically driven, and we propose that it is driven by a modification of superconducting condensate at H*.

Pairing mechanism in the ferromagnetic superconductor UCoGe

Superconductivity is a unique manifestation of quantum mechanics on a macroscopic scale, and one of the rare examples of many-body phenomena that can be explained by predictive, quantitative theories. The superconducting ground state is described as a condensate of Cooper pairs, and a major challenge has been to understand which mechanisms could lead to a bound state between two electrons, despite the large Coulomb repulsion. An even bigger challenge is to identify experimentally this pairing mechanism, notably in unconventional superconductors dominated by strong electronic correlations, like in high-Tc cuprates, iron pnictides or heavy-fermion compounds. Here we show that in the ferromagnetic superconductor UCoGe, the field dependence of the pairing strength influences dramatically its macroscopic properties like the superconducting upper critical field, in a way that can be quantitatively understood. This provides a simple demonstration of the dominant role of ferromagnetic spin fluctuations in the pairing mechanism.

A vinylic rotaxane cross-linker for toughened network polymers from the radical polymerization of vinyl monomers

A [2]rotaxane cross-linker with one vinyl group in each component was synthesized as a vinylic cross-linker for highly toughened network polymers.

Lifshitz Transitions in the Ferromagnetic Superconductor UCoGe

We present high field magnetoresistance, Hall effect and thermopower measurements in the Ising-type ferromagnetic superconductor UCoGe. A magnetic field is applied along the easy magnetization c axis of the orthorhombic crystal. In the different experimental probes, we observed five successive anomalies at H≈4, 9, 12, 16, and 21 T. Magnetic quantum oscillations were detected both in resistivity and thermoelectric power. At most of the anomalies, significant changes of the oscillation frequencies and the effective masses have been observed, indicating successive Fermi surface instabilities induced by the strong magnetic polarization under a magnetic field.

New heavy-fermion antiferromagnet UPd2Cd20

We succeeded in growing a new high quality single crystal of a ternary uranium compound UPd2Cd20. From the electrical resistivity, magnetization, magnetic susceptibility, and specific heat experiments, UPd2Cd20 is found to be an antiferromagnetic heavy-fermion compound with the Néel temperature [Formula: see text]  =  5 K and exhibits the large electronic specific heat coefficient γ exceeding 500 mJ (K(2)· mol)(-1). This compound is the first one that exhibits the magnetic ordering with the magnetic moments of the U atom in a series of UT2X20 (T: transition metal, X  =  Al, Zn, Cd). UPd2Cd20 shows typical characteristic features in heavy-fermion systems such as a broad maximum in the magnetic susceptibility at [Formula: see text] and a large coefficient A of T (2) term in the resistivity.

Field-induced spin-density wave beyond hidden order in URu2Si2

URu₂Si₂ is one of the most enigmatic strongly correlated electron systems and offers a fertile testing ground for new concepts in condensed matter science. In spite of >30 years of intense research, no consensus on the order parameter of its low-temperature hidden-order phase exists. A strong magnetic field transforms the hidden order into magnetically ordered phases, whose order parameter has also been defying experimental observation. Here, thanks to neutron diffraction under pulsed magnetic fields up to 40 T, we identify the field-induced phases of URu₂Si₂ as a spin-density-wave state. The transition to the spin-density wave represents a unique touchstone for understanding the hidden-order phase. An intimate relationship between this magnetic structure, the magnetic fluctuations and the Fermi surface is emphasized, calling for dedicated band-structure calculations.

The strongly-correlated electron system URu₂Si₂ possesses a hidden-order phase whose order parameter remains unidentified. Here, the authors demonstrate the development of spin-density-wave phases in URu₂Si₂ under high magnetic fields, providing a potential in-road to understanding this system.

Collapse of Ferromagnetism and Fermi Surface Instability near Reentrant Superconductivity of URhGe

We present thermoelectric power and resistivity measurements in the ferromagnetic superconductor URhGe for a magnetic field applied along the hard magnetization b axis of the orthorhombic crystal. Reentrant superconductivity is observed near the spin reorientation transition at H_{R}=12.75  T, where a first order transition from the ferromagnetic to the polarized paramagnetic state occurs. Special focus is given to the longitudinal configuration, where both the electric and heat current are parallel to the applied field. The validity of the Fermi-liquid T^{2} dependence of the resistivity through H_{R} demonstrates clearly that no quantum critical point occurs at H_{R}. Thus, the ferromagnetic transition line at H_{R} becomes first order implying the existence of a tricritical point at finite temperature. The enhancement of magnetic fluctuations in the vicinity of the tricritical point stimulates the reentrance of superconductivity. The abrupt sign change observed in the thermoelectric power with the thermal gradient applied along the b axis together with the strong anomalies in the other directions is definitive macroscopic evidence that in addition a significant change of the Fermi surface appears through H_{R}.

Omnidirectional Measurements of Angle-Resolved Heat Capacity for Complete Detection of Superconducting Gap Structure in the Heavy-Fermion Antiferromagnet UPd_{2}Al_{3}

Quasiparticle excitations in UPd_{2}Al_{3} were studied by means of heat-capacity (C) measurements under rotating magnetic fields using a high-quality single crystal. The field dependence shows C(H)∝H^{1/2}-like behavior at low temperatures for both two hexagonal crystal axes, i.e., H∥[0001] (c axis) and H∥[112[over ¯]0] (a axis), suggesting the presence of nodal quasiparticle excitations from heavy bands. At low temperatures, the polar-angle (θ) dependence of C exhibits a maximum along H∥[0001] with a twofold symmetric oscillation below 0.5 T, and an unusual shoulder or hump anomaly has been found around 30°-60° from the c axis in C(θ) at intermediate fields (1≲μ_{0}H≲2  T). These behaviors in UPd_{2}Al_{3} purely come from the superconducting nodal quasiparticle excitations, and can be successfully reproduced by theoretical calculations assuming the gap symmetry with a horizontal linear line node. We demonstrate the whole angle-resolved heat-capacity measurements done here as a novel spectroscopic method for nodal gap determination, which can be applied to other exotic superconductors.

Pressure cell for transport measurements under high pressure and low temperature in pulsed magnetic fields

We present a new specially designed pressure cell and technique adapted for resistivity measurements in pulsed magnetic fields up to 60 T at pressures up to at least 4 GPa, and temperatures down to 1.5 K. We show that heating effects during the pulse are acceptable (less than 1 K) and can be corrected allowing reliable temperature dependences of the magnetoresistance to be obtained. We illustrate the performance with a study of the phase diagram of the heavy fermion antiferromagnet CeRh2Si2.

Field-Induced Lifshitz Transition without Metamagnetism in CeIrIn(5)

We report high magnetic field measurements of magnetic torque, thermoelectric power, magnetization, and the de Haas-van Alphen effect in CeIrIn_{5} across 28 T, where a metamagnetic transition was suggested in previous studies. The thermoelectric power displays two maxima at 28 and 32 T. Above 28 T, a new, low de Haas-van Alphen frequency with a strongly enhanced effective mass emerges, while the highest frequency observed at low field disappears entirely. This suggests a field-induced Lifshitz transition. However, longitudinal magnetization does not show any anomaly up to 33 T, thus ruling out a metamagnetic transition at 28 T.

Reentrant superconductivity driven by quantum tricritical fluctuations in URhGe: evidence from ^{59}Co NMR in URh_{0.9}Co_{0.1}Ge

Our measurements of the ^{59}Co NMR spin-spin relaxation in URh_{0.9}Co_{0.1}Ge reveal a divergence of electronic spin fluctuations in the vicinity of the field-induced quantum critical point at H_{R}≈13  T, around which reentrant superconductivity (RSC) occurs in the ferromagnetic heavy fermion compound URhGe. We map out the strength of spin fluctuations in the (H_{b},H_{c}) plane of magnetic field components and show that critical fluctuations develop in the same limited region near the field H_{R} as that where RSC is observed. This strongly suggests these quantum fluctuations as the pairing glue responsible for the RSC. The fluctuations observed are characteristic of a tricritical point, followed by a phase bifurcation toward quantum critical end points.

Effectiveness of third-line chemotherapy in recurrent ovarian cancer patients

OBJECTIVE

Despite recent advances in the treatment of recurrent ovarian cancer, little evidence exists describing the benefit of third- line chemotherapy. The present authors previously reported that the treatment-free interval (TFI) after second-line chemotherapy may predict a survival benefit of third-line chemotherapy, however the length of TFI was uncertain due to limited cases. In this study, the authors evaluated the length of TFI, which is correlated with the effectiveness of third-line chemotherapy and a prognostic factor of third-line chemotherapy.

MATERIALS AND METHODS

The authors reviewed the medical records of 85 women with recurrent ovarian cancer who received third-line chemotherapy after a paclitaxel/carboplatin (PC) regimen as first-line chemotherapy.

RESULTS

The response rate [complete response (CR) + partial response (PR)] and clinical benefit rate [(CBR): CR + PR + stable disease (SD)] during the TFI after second-line chemotherapy for 0-3 months, 3-6 months, and 6-12 months and ≥ 12 months were 9.8%, 0%, 0%, 43.8% and 15.7%, 50%, 66.7%, and 93.8%, respectively. The median overall survival (OS) from the onset of third-line chemotherapy was longer for TFI ≥ 3 months than for TFI 0-3 months (795 days vs. 281 days, p < 0.001). Finally, according to univariate (HR = 0.256; p < 0.001) and multivariate (HR = 0.264; p < 0.001) analyses, TFI was the independent significant prognostic factor for OS.

CONCLUSIONS

TFI less than three months after second-line chemotherapy may predict little survival benefit of third-line chemotherapy.

Pathological factors associated with omental metastases in endometrial cancer

PURPOSE OF INVESTIGATION

This study aimed to assess the role of omentectomy in the surgical therapy of endometrial cancer. MATERI- ALS AND METHODS: A retrospective study was performed in 98 patients who were pathologically diagnosed with endometrial cancer and had initially undergone surgical therapy at the present institution. This study analyzed the relationship between omental metastasis and clinicopathological factors.

RESULTS

Omental metastasis was detected in nine patients (9%). On univariate analysis, significant number of omental metastatic lesions were detected in few cases by positive peritoneal cytology, adnexal metastasis, gross dissemination, and lymphovascular space involvement. On multivariate analysis, adnexal metastasis were a significant risk factor. The sensitivity of the spe- cial histological type and the specificity of the macroscopic peritoneal dissemination and adnexal metastasis were all high.

CONCLUSION

Omentectomy plays a significant role in determining the exact surgical staging in cases with non-endometrioid cancer, adnexal metas- tasis, and macroscopic peritoneal dissemination.

Symmetry of the excitations in the hidden order state of URu2Si2

We perform polarized electronic Raman scattering on URu2Si2 single crystals at low temperature down to 8 K in the hidden-order state and under a magnetic field up to 10 T. The hidden-order state is characterized by a sharp excitation at 1.7 meV and a gap in the electronic continuum below 6.8 meV. Both Raman signatures are of pure A2g symmetry. By comparing the behavior of the Raman sharp excitation and the neutron resonance at Q0=(0,0,1), we provide new evidence, constrained by selection rules of the two probes, that the hidden-order state breaks the translational symmetry along the c axis such that Γ and Z points fold on top of each other. The observation of these distinct Raman features with a peculiar A2g symmetry as a signature of the hidden-order phase places strong constraints on current theories of the hidden-order in URu2Si2.

Investigation of dyeing behavior of oxidative dye in fine structures of the human hair cuticle by nanoscale secondary ion mass spectrometry

BACKGROUND/PURPOSE

In oxidative coloring, the hair cuticle layers are not only the penetration pathway for active ingredients but also one of the most important dyeing regions. The dyeing mechanism of oxidative dyes in fine structures of the cuticle remains unclear. To investigate the dyeing behavior of oxidative dyes in fine structures of the cuticle, hair cross-sections were analyzed by nanoscale secondary ion mass spectrometry (NanoSIMS).

METHODS

The preparation method of hair cross-section for NanoSIMS measurement was improved. Improved hair cross-sections were analyzed using NanoSIMS.

RESULTS

The cuticle layer thickness of the hair cross-section could be widened. It was confirmed that (12) C(-) ions were more strongly detected from endocuticle than from other fine structures of cuticle. The NanoSIMS (12) C(-) image and hue saturation intensity (HSI) D(-) /(1) H(-) ratio image of the hair, dyed with deuterium-labeled oxidative dye, indicated that the endocuticle had a higher D(-) /(1) H(-) ratio than the other fine structures of the cuticle. It was substantiated that more colored chromophores were fixated in the endocuticle than in other fine structures of the cuticle.

CONCLUSION

The dyeing behavior of oxidative dyes in fine structures of hair cuticle was substantiated by NanoSIMS analysis using the improved hair cross-section preparation method.